The British Medical Association (BMA) called them “inefficient” and a “block between the GP and patient treatment”. NHS Clinical Commissioners said “in many cases” the centres “provide a useful and effective role”. All but 12 of the 209 Clinical Commissioning Groups (CCGs) in England responded to a BBC Freedom of Information (FoI) request. Sixty-one of them said they used some form of referral management centre. These centres were introduced in about 2003 and were designed to reduce NHS spending by limiting unnecessary referrals to hospital. However, one GP claimed cancer diagnoses were being delayed because of the extra bureaucracy. Since 2005 there has been a 10-fold increase in the use of referral centres. A BBC investigation revealed there had been a rise in referrals being rejected for administrative, rather than clinical reasons, with delays due to administration queries rising from 28% in 2013-14 to 41% last year. Dr Chaand Nagpaul, from the BMA, said: “It’s a blunt instrument which is not sensitive to the needs of the patient and is delaying patient care. “It has become totally mechanistic. It’s either administrative or not necessary for the patient. It’s completely unacceptable. Performance seems to be related to blocking referrals rather than patient care.” MPs in North Durham have complained about a centre which is paid £10 for every referral letter it processes. Some doctors in England are being offered thousands of pounds by CCGs to cut the number of patients being referred to hospital.